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PLATO analysis identifies factors contributing to lower mortality with ticagrelor
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The reduction in mortality found in patients assigned ticagrelor after CABG in the PLATO trial was associated with fewer deaths from CV, bleeding and infection complications, according to an analysis published in the Journal of the American College of Cardiology.
In the PLATO trial, patients who underwent CABG were randomly assigned ticagrelor (Brilinta, AstraZeneca) or clopidogrel. Those assigned ticagrelor had significantly lower mortality, both total and CV.
Christoph Varenhorst, MD, PhD, and colleagues conducted a further analysis of the PLATO data. They investigated outcomes of 1,261 patients who underwent CABG performed within 7 days after stopping the study drugs, and then classified causes of death (vascular and nonvascular) and bleeding or infection events that contributed to mortality.
More vascular deaths occurred in patients assigned clopidogrel, compared with ticagrelor, related to MI (14 vs. 10), HF (nine vs. six), arrhythmia or sudden death (nine vs. three), and bleeding, including hemorrhagic stroke (seven vs. two). More nonvascular deaths related to infection also were found in the clopidogrel group (eight vs. two).
Bleeding and infections, identified as factors directly causing or contributing to death, were less common in patients assigned ticagrelor (six vs. 16 infections; P<.05; 27 vs. nine bleeds; P<.01).
“Further studies are needed to investigate the underlying mechanisms responsible for the better survival after CABG in patients with ACS treated with ticagrelor,” the researchers wrote.
Disclosure: This study was supported by AstraZeneca. See the full study for the researchers’ relevant financial disclosures.
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